| NPI | 1467695965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 25915) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 25915) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 25915) | |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2023-12-11 |